Impact of Shorter Preoperative Fluid Fasting on Patient Outcomes: A Safe Brain Initiative Retrospective Cohort Analysis.

Background
Preoperative fasting practices can influence patient outcomes. Prolonged fasting can occur due to unclear instructions, misunderstandings, anxiety, and scheduling uncertainty. The aim of this study was to determine preoperative fluid-fasting time (FFT) in clinical practice and to assess how shorter FFT could impact patients and healthcare resources.Methods
A multicenter, retrospective observational analysis including 15,837 patients extracted from the Safe Brain Initiative care bundle (SBI-CB) database is presented. A part of the SBI-CB was to encourage FFT to be reduced to 2 hours as per guidelines. Four hospitals from Denmark and Turkey participated. Patients were >18 years old, scheduled for surgery, and able to communicate with healthcare staff. The primary outcomes were FFT, in hours, and the proportion of patients adherent to short FFT (2-4 hours) per month since the SBI-CB was initiated at each hospital. Secondary outcomes, comparing short with long (5-24 hours) FFT, included postoperative delirium in the recovery room, hospital length of stay in hours, and patient-reported outcome measures (PROMs) including thirst, pain, nausea/vomiting, stress/anxiety, and well-being. Sex, age, American Society of Anesthesia Physical Status Classification System category, surgery time, and use of general anesthesia were controlled for confounding effects by a one-to-many patient matching. Logistic and linear regressions were performed to adjust for the same confounding effects in addition to delirium at induction and site for the outcomes postoperative delirium and hospital stay.Results
Median (Q1-Q3) FFT was 5 (4-8) hours with a mean of 6.3 hours. 40.3% of patients adhered to the short FFT protocol of 2 to 4 hours. Prolonged FFT of at least 12 hours was experienced by 11.9% of patients. A significant positive correlation between SBI-CB implementation month and adherence to short FFT was observed (r = 0.7, P < .001). When comparing matched patients with short and long FFT, median hospital stay was significantly reduced by 18.0 hours (P < .001). Using logistic regression, short FFT was associated with a significant reduction in postoperative delirium with a log odds ratio [95% confidence interval] of 0.7 [0.6-0.8], P < .001. All measured PROMs were improved significantly with most benefits observed postoperatively.Conclusion
Adherence to a short FFT could be increased over time; however, many patients still experienced an FFT that should be considered too long. Implementation of short FFT was linked to enhanced patient outcomes and more efficient healthcare resource utilization. These findings underscore the importance of optimizing preoperative fasting practices to improve patient care and healthcare efficiency.